INTRODUCTION: Knowledge of the implementation gap would facilitate the use of intravenous thrombolysis in stroke, which is still low in many countries. The study was conducted to identify national implementation targets for the utilisation and logistics of intravenous thrombolysis. MATERIAL AND METHOD: Multicomponent interventions by stakeholders in health care to optimise prehospital and hospital management with the goal of fast and accessible intravenous thrombolysis for every candidate. Implementation results were documented from prospectively collected cases in all 45 stroke centres nationally. The thrombolytic rate was calculated from the total number of all ischemic strokes in the population of the Czech Republic since 2004. RESULTS: Thrombolytic rates of 1.3 (95%CI 1.1 to 1.4), 5.4 (95%CI 5.1 to 5.7), 13.6 (95%CI 13.1 to 14.0), 23.3 (95%CI 22.8 to 23.9), and 23.5% (95%CI 23.0 to 24.1%) were achieved in 2005, 2009, 2014, 2017, and 2018, respectively. National median door-to-needle times were 60-70 minutes before 2012 and then decreased progressively every year to 25 minutes (IQR 17 to 36) in 2018. In 2018, 33% of both university and non-university hospitals achieved median door-to-needle time ≤20 minutes. In 2018, door-to-needle times ≤20, ≤45, and ≤60 minutes were achieved in 39, 85, and 93% of patients. DISCUSSION: Thrombolysis can be provided to ≥ 20% of all ischemic strokes nationwide and it is realistic to achieve median door-to-needle time 20 minutes. CONCLUSION: Stroke 20-20 could serve as national implementation target for intravenous thrombolysis and country specific implementation policies should be applied to achieve such target.

Comprehensive Stroke Center University Hospital Hradec Kralove and Charles University Faculty of Medicine in Hradec Kralove Hradec Kralove Czech Republic

Department of Neurology 2nd Medical School of Charles University and Motol University Hospital Prague Czech Republic

Department of Neurology 3rd Medical School of Charles University and Vinohrady University Hospital Prague Czech Republic

Department of Neurology and AGEL Research and Training Institute Ostrava Vitkovice Hospital Ostrava Czech Republic

Department of Neurology Charles University Faculty of Medicine in Pilsen Pilsen Czech Republic

Department of Neurology Comprehensive Stroke Center Palacký University Medical School and Hospital Olomouc Czech Republic

Department of Neurology County Hospital Chomutov Chomutov Czech Republic

Department of Neurology Hospital Ceske Budejovice a s Ceske Budejovice Czech Republic

Department of Neurology Hospital Jihlava Jihlava Czech Republic

Department of Neurology Masaryk Hospital Usti nad Labem KZ a s Comprehensive Stroke Center Usti nad Labem Czech Republic

Department of Neurology University Faculty Hospital Ostrava and Faculty of Medicine University Ostrava Ostrava Czech Republic

Department of Neurology University Hospital Brno Brno Czech Republic

Department of Neurology University Hospital Pilsen Pilsen Czech Republic

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University Prague and Military University Hospital Prague Prague Czech Republic

Department of Nursing Faculty of Health Science Palacký University Olomouc Olomouc Czech Republic

Faculty of Medicine Masaryk University Brno Czech Republic

International Clinical Research Center and Department of Neurology St Anne's University Hospital Brno Brno Czech Republic

Neurocenter Regional Hospital Liberec Liberec Czech Republic

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